Provider Demographics
NPI:1053744243
Name:FROME, ROBERT MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:FROME
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1759 NW KINGS BLVD
Mailing Address - Street 2:BUILDING 5
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-1905
Mailing Address - Country:US
Mailing Address - Phone:541-753-3114
Mailing Address - Fax:
Practice Address - Street 1:1759 NW KINGS BLVD
Practice Address - Street 2:BUILDING 5
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-1905
Practice Address - Country:US
Practice Address - Phone:541-753-3114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD98801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice